Winter in the time of swine flu

SANTIAGO — Almost a third of healthcare workers around the country are on sick leave, traditional religious celebrations are being cancelled and everyone has a friend, relative, co-worker or neighbor on Tamiflu. And naturally, the pig jokes abound.

Yes, it’s the unrelenting spread of the H1N1 pandemic in Chile, fourth on the World Health Organization’s list of confirmed cases of the virus, with 7,376 infected, after the United States (33,902), Mexico (10,262) and Canada (7,983). New figures from Chile's own health ministry show that 40 have died and 10,926 have been infected in this country.

Why does this country of only 16 million inhabitants have such a disproportionally high number of people infected with the virus?

“The question is: are we diagnosing correctly in Chile, or are other countries not doing it adequately?” asked Jaime Honores, director of a public health clinic in Quilicura, a low-income district in northern Santiago.

It is probably the latter, said Enrique Paris, director of the Center for Toxicological Information and member of a government-appointed experts committee on the H1N1 virus.

“Compared to many other countries, the public and private health systems and university clinics in Chile have very advanced laboratories, so confirming the diagnosis is relatively easy. Other countries have to send their samples to Atlanta and wait for the results even for weeks, or don’t have the money to pay for them,” he said.

In Argentina, for instance, if there were more than 90 deaths caused by the virus, it is impossible for the number of people infected to be only 2,500 as has been reported, Paris said. “If the general mortality rate for this virus is 0.2 percent, the real number of people with the virus in Argentina should be over 45,000. They are just not confirming it with lab exams.”

Another reason for the massive contagion in Chile is simple: It’s winter, and in the capital, where about a third of the population is concentrated, the cold and dampness is aggravated by heavy air pollution. Respiratory illnesses including the seasonal influenza and the syncitial virus, which strikes young children, are always a serious strain on the health system during the winter months.

However, with this new virus, the situation has turned into a “sanitary emergency,” in the words of President Michelle Bachelet, especially when considering that the official figure includes only cases confirmed by laboratories. By now, the virus has become so widespread, that unless a patient specifically requests the expensive lab exam, doctors are diagnosing based only on symptoms.

Although the Health Ministry has ordered public and private health centers to record every dose of antiviral medicine they prescribe, and pharmacies must tally what they sell, there are still no official figures for the number of H1N1 patients based on the prescription of antivirals. Unofficially, it is estimated to be in the tens of thousands.

In Honores’ clinic, about 500 of the 1,200 patients they see a month are on antiviral medication. Like most of the public health sector, the clinic is dedicating most of its personnel, resources and attention to addressing this new virus, he said.

For the past few weeks, dozens of primary health centers have had to stay open on weekends because of the massive demand from patients with respiratory illnesses. In hospitals throughout the country, intensive care units, mechanic ventilators and beds are practically all being used by patients with influenza.

At least 5,000 previously programmed surgeries have been postponed in order to free up beds for incoming patients with influenza. Another 15,000 operations are expected to be suspended in the coming weeks.

At the same time, health workers are also getting sick: 30 percent of all staff in the public health system is on sick leave.

This scenario prompted the government to announce a new decree last week that allows, among other things, public health centers to hire medical students to help attend patients, and health authorities to suspend meetings, shows or other events to avoid further spread of the virus.

Even before the decree was issued, health officials had already cancelled the popular religious celebration Fiesta de La Tirana, which is held every year in mid-July in the tiny desert town of La Tirana, more than a thousand miles north of the capital, and attracts some 200,000 tourists and Catholics from all over the country. Shortly after, they cancelled the Fiesta de San Lorenzo, another annual religious event in the north of the country that gathers more than 70,000 Catholics during the second week of August.

Some private schools increased their winter breaks one or two weeks when their classrooms became practically empty.

“Chile is a showcase of how the virus really behaves. We’ve had experts from Germany, England, Egypt and the United States visit us who want to study how the virus behaves during the winter, because that will signal what will happen when it is winter in the Northern Hemisphere,” Paris said.

Health Minister Alvaro Erazo announced that Chile would buy an additional 600,000 doses of anti-viral medication from the Pan American Health Organization and laboratories. The government has also initiated conversations with international labs to reserve a stock of 6.2 million vaccines against the H1N1 virus for next year.

In spite of the alarming numbers, in terms of mortality, this virus is much less lethal than other respiratory illnesses in Chile: 2,593 people died from pneumonia last year.